Evaluation of a patient with an apparent freezing cold injury

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evaluation of a patient with an apparent freezing cold injury

obtain information on how and when the cold injury occurred

focus on factors which affects the severity e.g. - likely temperature, wind chill, and duration of exposure

additional information should focus on finding predisposing factors e.g - patient’s premorbid state, particularly history of peripheral vascular disease and smoking status

affected parts feel cold and possibly painful

continued freezing produce a paraesthesia or numbness (or both)

areas of blanching blending into areas of apparently uninjured skin



white and waxy skin with distinct demarcation from uninjured tissues

progression to bruising and blister formation (usually on thawing)

full extent of the injury may not be visible initially for few days. Therefore close observation is required

In true freezing cold injury, clinical appearance of the tissue can be used to identify the degree of injury:

Hallam MJ et al. Managing frostbite. BMJ. 2010;341:c5864.

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clinical appearance	mild frostbite injury	severe frostbite injury
first degree	second degree	third degree	fourth degree
depth of tissue freezing	partial thickness skin freezing	full thickness skin freezing	freezing of the skin and subcutaneous tissue	freezing of the skin, subcutaneous tissue, muscle, tendon, and bone
colour of tissues	erythematous or hyperaemic	erythematous	blue or black	initially deep red and mottled; eventually black and mummified
blistering or necrosis	none	blisters containing clear fluid	haemorrhagic blisters and some tissue necrosis	profound necrosis
oedema	minor	substantial	substantial	little or none

Evaluation of a patient with an apparent freezing cold injury

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